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Clearly Constitutional

Clearly Constitutional

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Ian Millhiser explains how the new health care reform law fits within the powers granted to Congress by the Constitution.
Ian Millhiser explains how the new health care reform law fits within the powers granted to Congress by the Constitution.

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Published by: Center for American Progress on Jan 18, 2011
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01/18/2011

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1Center for American Progress | Clearly Constitutional
Clearly Constitutional
A Primer on the Constitutionality of the Affordable Care Act
Ian Millhiser January 18, 2011
Introduction
Nearly hree dozen judges have now considered challenges o he landmark  Aordable Care Ac and he overwhelming majoriy o hese cases have beendismissed. Neverheless, a single oulier judge in Virginia has embraced he meri-less argumens agains he new healh care law and anoher judge in Florida alsoappears poised o break wih he overwhelming consensus o his colleagues. Wih only a ew excepions, hese lawsuis principally challenge he AordableCare Ac’s minimum coverage provision—he provision requiring mos Americanso eiher carry healh insurance or pay slighly more income axes—alsely arguingha Congress lacks he consiuional auhoriy o enac such a provision. I is rueha Congress’s auhoriy is limied o an iemized lis o powers conained in heex o he Consiuion isel, bu while Congress’s powers are no unlimied, hey are sill quie sweeping. Tere is no doub ha he Aordable Care Ac s wihinhese enumeraed powers in hree ways, as his issue brie will demonsrae.
Congress has broad power to regulate the national economy
 A provision o he Consiuion known as he “commerce clause” gives Congresspower o “regulae commerce … among he several saes.” And here is a longline o Supreme Cour decisions holding ha Congress has broad power o enaclaws ha subsanially aec prices, markeplaces, or oher economic ransacions.Because healh care comprises approximaely 17 percen o he naional economy,i is impossible o argue ha a bill regulaing he naional healh care marke doesno  wihin Congress’s power o regulae commerce.
 
2Center for American Progress | Clearly Constitutional
Neverheless, opponens o he Aordable Care Ac claim ha a person who doesno buy healh insurance is no engaged in any economic “aciviy” and hereorecanno be compelled o perorm an undesired ac. Even i hese opponens werecorrec ha he uninsured are no acive paricipans in he healh care mar-ke—and hey are acive, o course, every ime hey become ill and seek medicalcare—nohing in he Consiuion suppors his novel heory. Indeed, his heory appears o have been invened solely or he purpose o his liigaion. Congresshas enaced counless laws which would be orbidden under his exra-consiu-ional heory:
•
Guns
:
Presiden George Washingon signed a law ha required much o hecounry o purchase a rearm, ammuniion, and oher equipmen in case hey needed o be called up or miliia service. Many o he members o Congress who voed or his mandae were members o he Philadelphia Convenion ha wroe he Consiuion.
•
Civil rights
:
Te Civil Righs Ac o 1964 compelled business owners o engagein ransacions hey considered undesirable—hiring and oherwise doing busi-ness wih Arican Americans.
•
Insurance mandates
:
Te Aordable Care Ac is no even he only ederal law requiring someone o carry insurance. Te Price-Anderson Ac o 1957 requiresnuclear power plans o purchase liabiliy insurance and he Flood DisaserProecion Ac requires many homeowners o carry ood insurance.
•
Other mandates
:
Oher laws require individuals o perorm jury service, le ax reurns, and regiser or selecive service.
 The minimum coverage provision is the keystone that holds theAffordable Care Act together
Te Consiuion also gives Congress he power “[]o make all laws which shall benecessary and proper or carrying ino execuion” is power o regulae inersaecommerce. As Supreme Cour Jusice Anonin Scalia explains, his means ha“where Congress has he auhoriy o enac a regulaion o inersae commerce, ipossesses every power needed o make ha regulaion eecive.Te ac eliminaes one o he insurance indusrys mos abusive pracices—deny-
 
3Center for American Progress | Clearly Constitutional
ing coverage o paiens wih pre-exising condiions. Tis ban canno uncion i paiens are ree o ener and exi he insurance marke a will. I paiens can waiunil hey ge sick o buy insurance, hey will drain all he money ou o an insur-ance plan ha hey have no previously paid ino, leaving nohing lef or he reso he plan’s consumers.Seven saes enaced a pre-exising condiions law wihou also passing an insur-ance coverage requiremen, and all seven saes saw healh insurance premiumsspiral ou o conrol. In some o hese saes, he individual insurance marke col-lapsed. Tere is a way ou o his rap, however. Massachusets enaced a minimumcoverage provision in 2006 o go along wih is pre-exising condiions provisionand he resuls were boh sriking and immediae. Massachusets’ premiums rap-idly dropped by 40 percen.In oher words, because he only way o make he pre-exising condiions law eecive is o also require individuals o carry insurance, ha requiremen easily passes Scalia’s es.Te link beween he minimum coverage provision and he Aordable Care Ac’sinsurance regulaions also ses his law aside rom oher hypoheical laws requir-ing individuals o purchase oher goods or services. Te naional marke or veg-eables will no collapse i Congress does no require people o purchase broccoli,nor will Americans cease o be able o obain auomobiles absen a law requiringhe purchase o cars rom General Moors. Accordingly, a cour decision uphold-ing he Aordable Care Ac would no provide a preceden enabling Congress ocompel all Americans o purchase broccoli or cars, despie he law’s opponens’claims o he conrary.
Congress has broad leeway in how it raises money
Congress also has he auhoriy o “lay and collec axes” under he Consiuion.Tis power o ax also suppors he minimum coverage provision, which works by requiring individuals who do no carry healh insurance o pay slighly moreincome axes. axpayers who reuse insurance mus pay more in axes while hose who do carry insurance are exemp rom his new ax. For his reason, he law isno dieren han dozens o longsanding ax exempions, including he morgageineres ax deducion, which allows people who ake ou home morgages o pay lower axes han people who do no.

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